2018 - Clinical Policy Bulletins

2018 - Other plan information

These drugs appear in the main list, but have been grouped into categories to make them easier to find.

HSA-associated plans: Prescription drugs on the Preventive list below will be covered as if you have already met your deductible. You are responsible only for your copay.

HRA-associated plans: Prescription drugs on the Preventive list and/or the Chronic list below could be covered as if you already met your deductible. You would be responsible only for your copay. To find out which lists apply to you, check your plan benefits documents.

Preventive drugs and products
Under health care reform, you can get some drugs and products with no member cost share. This means they are covered 100 percent by your plan. This list shows some common examples.

Exclusions Drug List
The drugs on this list are not covered under your plan. There are similar products with the same active ingredients that are covered. The list shows you the non-covered drugs and the similar covered ones.

Aetna Healthy Actions℠ program – This program provides certain services and drugs to eligible members at low or no cost. Check with your employer to see if these lists apply.

Aetna Specialty Formulary Drug List
Specialty drugs treat complex conditions that often require support by a nurse or pharmacist during treatment. These drugs may be injected, infused or taken orally and may require special handling.

Medical exceptions for non-covered drugs

Expedited medical exceptions

In certain circumstances*, you or your prescriber can request a medical exception for a non-covered drug. To submit a request, call our Precertification Department at 1-855-582-2025, or fax a request to 1-855-330-1716. You also can mail a written request to Aetna PA, 1300 E. Campbell Rd., Richardson, TX 75081. We will make a coverage determination within 24 hours of receiving the request, and notify you or your prescriber of our decision.

*These circumstances exist when you are suffering from a health condition that may seriously jeopardize your life, health, or ability to regain maximum function, or undergoing a current course of treatment using a non-covered drug.

About your drug list

What is a formulary?

A formulary is a list of drugs covered under your plan, with details about the type of coverage. You may hear the word "formulary" during a doctor’s visit or when you pick up a prescription.

Does the main list include every covered drug?

Your pharmacy benefits plan includes thousands of drugs – too many to list. So your main drug list contains only the most commonly prescribed drugs.

For current Aetna members, to check coverage and copay information for a specific medicine log in to your secure member website.

This material is for information only. Aetna Specialty Pharmacy refers to Aetna Specialty Pharmacy, LLC, a subsidiary of Aetna Inc., which is a licensed pharmacy that operates through specialty pharmacy prescription fulfillment. The drugs on the Preferred Drug List Formulary Exclusions, Precertification, Quantity Limit and Step-Therapy Lists are subject to change. The precertification, quantity limits and step-therapy drug coverage review programs are not available in all service areas. For example, precertification and step therapy programs do not apply to fully insured members in Indiana. Step therapy does not apply to fully insured members in New Jersey. However, these programs are available to self-insured plans.

Information is believed to be accurate as of the production date; however, it is subject to change.

JavaScript is required

In order to have the best experience on Aetna.com, Javascript needs to be enabled.Learn how to change your browser settings to enable Javascript.

You are now leaving the Aetna website

Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.

This search uses the five-tier version of this plan

Each main plan type has more than one subtype. Some subtypes have five tiers of coverage. Others have four tiers, three tiers or two tiers. This search will use the five-tier subtype. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Do you want to continue?